Provider Demographics
NPI:1376909770
Name:MARCHESSAULT, SARA JEANNE (PA-C, FNP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEANNE
Last Name:MARCHESSAULT
Suffix:
Gender:F
Credentials:PA-C, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0014
Mailing Address - Country:US
Mailing Address - Phone:541-273-2634
Mailing Address - Fax:541-273-1147
Practice Address - Street 1:501 MAIN ST STE 308
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6049
Practice Address - Country:US
Practice Address - Phone:541-273-2634
Practice Address - Fax:541-273-1147
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53104363AM0700X
CA95003479363LF0000X
OR201702046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical